Provider Demographics
NPI:1619400322
Name:HUDSON, SERBRINA N
Entity Type:Individual
Prefix:MRS
First Name:SERBRINA
Middle Name:N
Last Name:HUDSON
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:SERBRINA
Other - Middle Name:N
Other - Last Name:TENNELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12905 SW 286TH ST
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-7459
Mailing Address - Country:US
Mailing Address - Phone:786-258-4063
Mailing Address - Fax:
Practice Address - Street 1:14405 SW 107TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-7501
Practice Address - Country:US
Practice Address - Phone:786-258-4063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-10
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHB93271744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management